Correlation of Facial Fracture Patterns With Neurotrauma: A Cross-Sectional Study From R Adams Cowley Shock Trauma Center
Colton McNichols, M.D.1, Silviu Diaconu, M.D.2, Corey Mossop, M.D.3, Yvonne Rasko, M.D.4, Michael P. Grant, M.D., PhD.2, Arthur Nam, M.D.2.
1Johns Hopkins Hospital, Baltimore, MD, USA, 2R Adams Cowley Shock Trauma Center, Baltimore, MD, USA, 3Walter Reed National Military Medical Center, Bethesda, MD, USA, 4University of Maryland Medical Center, Baltimore, MD, USA.
BACKGROUND: Relationships between patterns of facial fractures and worsening degrees of traumatic brain injury (TBI) are poorly understood. The incidence of facial fractures in the setting of TBI has been reported to be as high as 86%. Since TBI presents along a spectrum of functionality, we have decided to measure it using the validated Glasgow Outcomes Scale (GOS). The purpose of this study is to define the potentially significant relationships between specific patterns of facial fractures and worsening GOS.
METHODS: Patients were identified using ICD-9 codes for TBI from 2011-2014. These subjects were analyzed to determine the type of facial fracture(s) (if present) they had in addition to GOS upon discharge. Facial fractures were analyzed individually in addition to: upper 1/3 of face, middle 1/3, lower 1/3, upper/middle, middle/lower, panfacial, and skull base. Using chi-square analysis with SPSS (IBM Armonk, NY), we were able to determine which type of fractures resulted in a poor outcome.
RESULTS: A total of 844 patients were included. Of these, 76% were male and 24% were female with an age range of 13-97 years old. The majority of injuries were due to fall (33%) and motor vehicle collision (24%). Ninety-six percent of patients had at least one facial fracture. Forty-six percent of patients had a skull-base fracture. Facial fracture pattern incidence, from highest to lowest, was as follows: middle only (47%), upper and middle (28%), upper only (10%), middle and lower (7%), lower only (4%) and panfacial (4%). The most common facial fracture was isolated orbit (17%). Older patients were more likely to have worse outcomes. Patients with a skull base fracture were 70% more likely to die compared to those without a skull base fracture. Of the facial fracture patterns, panfacial injuries were three times more likely to require skilled-nursing/rehabilitation facility placement. The remainder of facial fractures and patterns had no significant impact on our measured outcomes.
CONCLUSIONS: Outcomes in TBI patients were significantly worse in patients with panfacial injuries and skull base fractures. Patients with skull base fractures had a higher mortality risk and panfacial fractures were more likely to require discharge to a skilled-nursing/rehabilitation facility. As age increases, the outcomes worsen proportionally. These prognosticators may have a role in family discussions and risk stratification.
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